Prasugrel or double-dose clopidogrel to overcome clopidogrel low-response-The TAILOR (Thrombocytes And IndividuaLization of ORal antiplatelet therapy in percutaneous coronary intervention) randomized trial

Nadia Paarup Dridi*, Pär Ingemar Johansson, Peter Clemmensen, Trine Stissing, Maria Dumitrela Radu, Abbas Qayyum, Frants Pedersen, Steffen Helqvist, Kari Saunamäki, Henning Kelbæk, Erik Jorgensen, Thomas Engstrom, Lene Holmvang

*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskriftArtikelForskningpeer review

Abstract

High on-treatment platelet reactivity (HTPR) is associated with poor prognosis in patients undergoing percutaneous coronary intervention (PCI). The antiplatelet effect and safety of prasugrel was compared to that of double-dose clopidogrel in patients with stable coronary artery disease or acute coronary syndrome (ACS) exhibiting HTPR on clopidogrel and treated with PCI, using multiple electrode aggregometry (MEA) to assess platelet reactivity. Of 923 patients screened, 237 (25.7%) exhibited HTPR. Of these, 106 were eligible for participation in a randomized trial comparing two intensified antiplatelet regimen: 52 were assigned to double maintenance-dose clopidogrel and 54 to standard-dose prasugrel. At 1 month, tailoring antiplatelet therapy improved platelet inhibition to a level considered as therapeutic in 73.1% of patients. Prasugrel entailed greater platelet inhibition (p=0.02) and a lower rate of persisting HTPR at follow-up compared to double-dose clopidogrel (HTPR persisted in 20.4% and 42% respectively, p=0.02). Within the 30-day follow-up, no major bleeds were observed and the incidence of major adverse cardiovascular events (MACE) was similar in the two treatment arms. Prasugrel demonstrated superiority to double-dose clopidogrel in overcoming HTPR and reducing platelet activity. Intensifying antiplatelet therapy in both ACS and stable angina pectoris (SAP) patients exhibiting HTPR prior to PCI was well tolerated.

OriginalsprogEngelsk
Sider (fra-til)506-512
Antal sider7
TidsskriftPlatelets
Vol/bind25
Udgave nummer7
DOI
StatusUdgivet - 1 nov. 2014
Udgivet eksterntJa

Fingeraftryk

Udforsk hvilke forskningsemner 'Prasugrel or double-dose clopidogrel to overcome clopidogrel low-response-The TAILOR (Thrombocytes And IndividuaLization of ORal antiplatelet therapy in percutaneous coronary intervention) randomized trial' indeholder.

Citationsformater